Semin Musculoskelet Radiol 2023; 27(02): 182-197
DOI: 10.1055/s-0043-1762593
Review Article

Imaging of Anatomical Variants Around the Hip

Michail E. Klontzas*
1   Department of Radiology, School of Medicine, University of Crete, Crete, Greece
2   Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology, Heraklion, Crete, Greece
3   Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
,
Evangelia E. Vassalou*
3   Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
4   Department of Radiology, General Hospital of Sitia, Xerokamares, Sitia, Lasithi, Crete, Greece
,
Aristeidis H. Zibis
5   Department of Anatomy, Faculty of Medicine, University of Thessaly, Larissa, Greece
,
Apostolos H. Karantanas
1   Department of Radiology, School of Medicine, University of Crete, Crete, Greece
2   Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology, Heraklion, Crete, Greece
3   Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
› Institutsangaben

Abstract

Considering the current widespread use of imaging as an integral part of managing hip pain, variable hip geometries and anatomical variants are increasingly being detected. These variants are commonly found in the acetabulum and proximal femur, as well as the surrounding capsule-labral tissues. The morphology of specific anatomical spaces confined by the proximal femur and the bony pelvis may also vary significantly among individuals. Familiarity with the spectrum of imaging appearances of the hip is necessary to identify variant hip morphologies with or without potential clinical relevance and reduce an unnecessary work-up and overdiagnosis. We describe anatomical variations and variable morphologies of the bony structures comprising the hip joint and the soft tissues, around the hip. The potential clinical significance of these findings is further analyzed in conjunction with the patient's profile.

* These authors contributed equally to the article.




Publikationsverlauf

Artikel online veröffentlicht:
03. April 2023

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  • References

  • 1 Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 2003; (417) 112-120
  • 2 Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84 (04) 556-560
  • 3 Mascarenhas VV, Rego P, Dantas P, Gaspar A, Soldado F, Consciência JG. Cam deformity and the omega angle, a novel quantitative measurement of femoral head-neck morphology: a 3D CT gender analysis in asymptomatic subjects. Eur Radiol 2017; 27 (05) 2011-2023
  • 4 Mascarenhas VV, Rego P, Dantas P. et al. Can we discriminate symptomatic hip patients from asymptomatic volunteers based on anatomic predictors? A 3-dimensional magnetic resonance study on cam, pincer, and spinopelvic parameters. Am J Sports Med 2018; 46 (13) 3097-3110
  • 5 Pitt MJ, Graham AR, Shipman JH, Birkby W. Herniation pit of the femoral neck. AJR Am J Roentgenol 1982; 138 (06) 1115-1121
  • 6 Kavanagh L, Byrne C, Kavanagh E, Eustace S. Symptomatic synovial herniation pit-MRI appearances pre and post treatment. BJR Case Rep 2017; 3 (02) 20160103
  • 7 Crabbe JP, Martel W, Matthews LS. Rapid growth of femoral herniation pit. AJR Am J Roentgenol 1992; 159 (05) 1038-1040
  • 8 Boldt FK, Fritz B, Zingg PO, Sutter R, Pfirrmann CWA. Osseous defect of the anteroinferior femoral head: is it associated with femoroacetabular impingement (FAI)?. Skeletal Radiol 2021; 50 (09) 1781-1790
  • 9 Panzer S, Esch U, Abdulazim AN, Augat P. Herniation pits and cystic-appearing lesions at the anterior femoral neck: an anatomical study by MSCT and microCT. Skeletal Radiol 2010; 39 (07) 645-654
  • 10 Kim CH, Han S, Yang CJ, Kim JH. Correlation between the presence of herniation pit and femoroacetabular impingement: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2020; 28 (10) 3365-3373
  • 11 Kim JA, Park JS, Jin W, Ryu K. Herniation pits in the femoral neck: a radiographic indicator of femoroacetabular impingement?. Skeletal Radiol 2011; 40 (02) 167-172
  • 12 Liu RW, Toogood P, Hart DE, Davy DT, Cooperman DR. The effect of varus and valgus osteotomies on femoral version. J Pediatr Orthop 2009; 29 (07) 666-675
  • 13 Fabry G, MacEwen GD, Shands Jr ARJ. Torsion of the femur. A follow-up study in normal and abnormal conditions. J Bone Joint Surg Am 1973; 55 (08) 1726-1738
  • 14 Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clin Orthop Relat Res 2013; 471 (12) 3774-3780
  • 15 Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CWA. Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 2012; 263 (02) 475-483
  • 16 Pylkkanen PV. Coxa vara infantum. Acta Orthop Scand Suppl 1960; 48: 1-120
  • 17 Beall DP, Martin HD, Mintz DN. et al. Anatomic and structural evaluation of the hip: a cross-sectional imaging technique combining anatomic and biomechanical evaluations. Clin Imaging 2008; 32 (05) 372-381
  • 18 Zucker EJ, Lee EY, Restrepo R, Eisenberg RL. Hip disorders in children. AJR Am J Roentgenol 2013; 201 (06) W776–W796
  • 19 Nötzli HP, Müller SM, Ganz R. The relationship between fovea capitis femoris and weight bearing area in the normal and dysplastic hip in adults: a radiologic study [in German]. Z Orthop Ihre Grenzgeb 2001; 139 (06) 502-506
  • 20 Beltran LS, Mayo JD, Rosenberg ZS. et al. Fovea alta on MR images: is it a marker of hip dysplasia in young adults?. AJR Am J Roentgenol 2012; 199 (04) 879-883
  • 21 Pitt MJ, Morgan SL, Lopez-Ben R. et al. Association of the presence of bone bars on radiographs and low bone mineral density. Skeletal Radiol 2011; 40 (07) 905-911
  • 22 Sarver DB, Lopez-Ben R, Morgan SL. et al. Association of the presence of bone bars on radiographs and hip fracture in postmenopausal Caucasian women. Clin Radiol 2012; 67 (09) 840-842
  • 23 Hayashi D, Frank W, Roemer FW. et al. Latest advancements in imaging techniques in OA. Ther Adv Musculoskelet Dis 2022; 14 DOI: 10.1177/1759720X221146621.
  • 24 Lequesne M, Malghem J, Dion E. The normal hip joint space: variations in width, shape, and architecture on 223 pelvic radiographs. Ann Rheum Dis 2004; 63 (09) 1145-1151
  • 25 Bencardino JT, Kassarjian A, Vieira RLR, Schwartz R, Mellado JM, Kocher M. Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain. Skeletal Radiol 2011; 40 (04) 415-421
  • 26 Katz LD, Haims A, Medvecky M, McCallum J. Symptomatic hip plica: MR arthrographic and arthroscopic correlation. Skeletal Radiol 2010; 39 (12) 1255-1258
  • 27 DuBois DF, Omar IM. MR imaging of the hip: normal anatomic variants and imaging pitfalls. Magn Reson Imaging Clin N Am 2010; 18 (04) 663-674
  • 28 Blankenbaker DG, Davis KW, De Smet AA, Keene JS. MRI appearance of the pectinofoveal fold. AJR Am J Roentgenol 2009; 192 (01) 93-95
  • 29 Thomas JD, Li Z, Agur AM, Robinson P. Imaging of the acetabular labrum. Semin Musculoskelet Radiol 2013; 17 (03) 248-257
  • 30 Lecouvet FE, Vande Berg BC, Malghem J. et al. MR imaging of the acetabular labrum: variations in 200 asymptomatic hips. AJR Am J Roentgenol 1996; 167 (04) 1025-1028
  • 31 Aydingöz U, Oztürk MH. MR imaging of the acetabular labrum: a comparative study of both hips in 180 asymptomatic volunteers. Eur Radiol 2001; 11 (04) 567-574
  • 32 Nguyen MS, Kheyfits V, Giordano BD, Dieudonne G, Monu JUV. Hip anatomic variants that may mimic abnormalities at MRI: labral variants. AJR Am J Roentgenol 2013; 201 (03) W394-W400
  • 33 Saddik D, Troupis J, Tirman P, O'Donnell J, Howells R. Prevalence and location of acetabular sublabral sulci at hip arthroscopy with retrospective MRI review. AJR Am J Roentgenol 2006; 187 (05) W507-11
  • 34 Kwee RM, Kavanagh EC, Adriaensen MEAPM. Normal anatomical variants of the labrum of the hip at magnetic resonance imaging: a systematic review. Eur Radiol 2013; 23 (06) 1694-1710
  • 35 Blankenbaker DG, De Smet AA, Keene JS, Fine JP. Classification and localization of acetabular labral tears. Skeletal Radiol 2007; 36 (05) 391-397
  • 36 Studler U, Kalberer F, Leunig M. et al. MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear. Radiology 2008; 249 (03) 947-954
  • 37 Petersilge C. Imaging of the acetabular labrum. Magn Reson Imaging Clin N Am 2005; 13 (04) 641-652 , vi
  • 38 Petersilge CA. MR arthrography for evaluation of the acetabular labrum. Skeletal Radiol 2001; 30 (08) 423-430
  • 39 Czerny C, Hofmann S, Neuhold A. et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996; 200 (01) 225-230
  • 40 Patel K, Wallace R, Busconi BD. Radiology. Clin Sports Med 2011; 30 (02) 239-283
  • 41 Philippon MJ, Faucet SC, Briggs KK. Arthroscopic hip labral repair. Arthrosc Tech 2013; 2 (02) e73-e76
  • 42 Walker M, Maini L, Kay J. et al. The dimensions of the hip labrum can be reliably measured using magnetic resonance and computed tomography which can be used to develop a standardized definition of the hypoplastic labrum. Knee Surg Sports Traumatol Arthrosc 2021; 29 (05) 1432-1452
  • 43 Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy 2010; 26 (06) 750-756
  • 44 Abe I, Harada Y, Oinuma K. et al. Acetabular labrum: abnormal findings at MR imaging in asymptomatic hips. Radiology 2000; 216 (02) 576-581
  • 45 Vahedi H, Aalirezaie A, Azboy I, Daryoush T, Shahi A, Parvizi J. Acetabular labral tears are common in asymptomatic contralateral hips with femoroacetabular impingement. Clin Orthop Relat Res 2019; 477 (05) 974-979
  • 46 Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med 2012; 40 (12) 2720-2724
  • 47 Vogel LA, Kraeutler MJ, Jesse MK. et al. The everted acetabular labrum: patho-anatomy, magnetic resonance imaging and arthroscopic findings of a native variant. Arthroscopy 2022; 38 (01) 72-79
  • 48 Shirai Y, Wakabayashi K, Wada I, Tsuboi Y, Ha M, Otsuka T. Magnetic resonance imaging evaluation of the labrum to predict acetabular development in developmental dysplasia of the hip: a STROBE compliant study. Medicine (Baltimore) 2017; 96 (21) e7013
  • 49 Cerezal L, Kassarjian A, Canga A. et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics 2010; 30 (06) 1637-1651
  • 50 Papavasiliou A, Siatras T, Bintoudi A. et al. The gymnasts' hip and groin: a magnetic resonance imaging study in asymptomatic elite athletes. Skeletal Radiol 2014; 43 (08) 1071-1077
  • 51 Kassarjian A, Brisson M, Palmer WE. Femoroacetabular impingement. Eur J Radiol 2007; 63 (01) 29-35
  • 52 Karantanas AH. Pelvis/Hip: adult. In: Cassar-Pullicino VN, Davies MA. eds. Measurements in Musculoskeletal Radiology. Berlin, Germany: Springer; 2020: 459-516
  • 53 Anderson LA, Kapron AL, Aoki SK, Peters CL. Coxa profunda: is the deep acetabulum overcovered?. Clin Orthop Relat Res 2012; 470 (12) 3375-3382
  • 54 Nepple JJ, Lehmann CL, Ross JR, Schoenecker PL, Clohisy JC. Coxa profunda is not a useful radiographic parameter for diagnosing pincer-type femoroacetabular impingement. J Bone Joint Surg Am 2013; 95 (05) 417-423
  • 55 Larson CM, LaPrade RF, Floyd ER, McGaver RS, Bedi A. Acetabular rim disorders/pincer-type femoroacetabular impingement and hip arthroscopy. Sports Med Arthrosc Rev 2021; 29 (01) 35-43
  • 56 Hergan K, Oser W, Moriggl B. Acetabular ossicles: normal variant or disease entity?. Eur Radiol 2000; 10 (04) 624-628
  • 57 Djaja YP, Kim S, Lee GY, Ha YC. Acetabular ossicles: epidemiology and correlation with femoroacetabular impingement. Arthroscopy 2020; 36 (04) 1063-1073
  • 58 Randelli F, Maglione D, Favilla S, Capitani P, Menon A, Randelli P. Os acetabuli and femoro-acetabular impingement: aetiology, incidence, treatment, and results. Int Orthop 2019; 43 (01) 35-38
  • 59 Nguyen MS, Kheyfits V, Giordano BD, Dieudonne G, Monu JUV. Hip anatomic variants that may mimic pathologic entities on MRI: nonlabral variants. AJR Am J Roentgenol 2013; 201 (03) W401–W408
  • 60 Martinez AE, Li SM, Ganz R, Beck M. Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim?. Hip Int 2006; 16 (04) 281-286
  • 61 Omoumi P, Vande Berg B. vande Berg B. Hip imaging: normal variants and asymptomatic findings. Semin Musculoskelet Radiol 2017; 21 (05) 507-517
  • 62 Boutris N, Gardner SL, Yetter TR, Delgado DA, Pulido L, Harris JD. MRI prevalence and characteristics of supraacetabular fossae in patients with hip pain. Hip Int 2018; 28 (05) 542-547
  • 63 Dietrich TJ, Suter A, Pfirrmann CWA, Dora C, Fucentese SF, Zanetti M. Supraacetabular fossa (pseudodefect of acetabular cartilage): frequency at MR arthrography and comparison of findings at MR arthrography and arthroscopy. Radiology 2012; 263 (02) 484-491
  • 64 Vaeth D, Dietrich TJ, Wildermuth S. et al. Age dependent prevalence of the supraacetabular fossa in children, adolescents and young adults. Insights Imaging 2022; 13 (01) 91
  • 65 Lien LC, Hunter JC, Chan YS. Tubular acetabular intraosseous contrast tracking in MR arthrography of the hip: prevalence, clinical significance, and mechanisms of development. AJR Am J Roentgenol 2006; 187 (03) 807-810
  • 66 Kivlan BR, Martin RL, Martin HD. Ischiofemoral impingement: defining the lesser trochanter-ischial space. Knee Surg Sports Traumatol Arthrosc 2017; 25 (01) 72-76
  • 67 Torriani M, Souto SCL, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol 2009; 193 (01) 186-190
  • 68 Won H, Lee YK, Lee BS, Park JW, Won S, Koo KH. Normal ischiofemoral distance and its associated factors: computed tomography-based study. Arthroscopy 2020; 36 (01) 150-155
  • 69 Hujazi I, Jones T, Johal S, Bearcroft P, Muniz-Terra G, Khanduja V. The normal ischiofemoral distance and its variations. J Hip Preserv Surg 2016; 3 (03) 197-202
  • 70 Klontzas ME, Karantanas AH. Greater trochanter pain syndrome: a descriptive MR imaging study. Eur J Radiol 2014; 83 (10) 1850-1855
  • 71 Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol 2008; 190 (03) 576-581
  • 72 Unat F, Sirinturk S, Cagimni P. et al. Macroscopic observations of muscular bundles of accessory iliopsoas muscle as the cause of femoral nerve compression. J Orthop 2018; 16 (01) 64-68